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• W2215928790 abstract "We thank Parminder Judge and Christopher Winearls, Eric Smith, Mohamad Zaidan, and Soham Rej and colleagues for their comments on our study1Shine B McKnight RF Leaver L Geddes JR Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data.Lancet. 2015; 386: 461-468Summary Full Text Full Text PDF PubMed Scopus (161) Google Scholar and helpful suggestions for future investigation.As Judge and Winearls suggest, end-stage renal failure in a patient given lithium could obviously be attributable to factors other than the lithium itself and large-scale, well-controlled prospective studies that investigate various confounders are needed to refine the hazard ratios more exactly. A study combining MRI with biochemical markers would be ideal. We did not look at proteinuria, but the data are available and it seems that many patients with lithium-related nephropathy do not have proteinuria.2Grunfeld JP Rossier BC Lithium nephrotoxicity revisited.Nat Rev Nephrol. 2009; 5: 270-276Crossref PubMed Scopus (215) Google Scholar We would agree that lithium could be continued in selected patients in the context of high intensity renal monitoring.Smith poses an important question: how does age of onset of lithium therapy affect the risk of declining renal function? We did not analyse these data in our initial report, but we will in a planned follow-up study. As far as we know, this question has not been addressed elsewhere, but we welcome other researchers' contributions if they have already looked at such data.We agree with Zaidan that there are limitations in our data, especially those pertaining to a paucity of information about concurrent drugs and cardiovascular comorbidities. We used routinely collected, anonymised biochemical data with no linked clinical details, but these variables should be included in prospective multispecialty studies. To address Zaidan's other points: the number of creatinine measurements is recorded in table 1; age is age at first measurement; 14·6% of patients had eGFR 60 mL/min per 1·73 m2 or less at first measurement, and were excluded from the subsequent analysis. Chronic kidney disease progression and end-stage renal disease will be included in a follow-up study.We agree with most of Rej and colleagues' comments. Unfortunately, our use of routine biochemical data not linked to clinical diagnoses meant that a control group could not be established. Similarly, it is not possible to control for other confounders such as cardiovascular disease, smoking, or antipsychotic drug use. We did not control for inflammatory markers, but the suggestion is interesting, and will be explored in a follow-up study. To clarify, the oldest patients were aged 100 years in both groups (not 67) and 116 patients receiving lithium were aged 80 years or older at first creatinine measurement, of a total of 66 541 people aged 80 years or more in the population.We declare no competing interests. We thank Parminder Judge and Christopher Winearls, Eric Smith, Mohamad Zaidan, and Soham Rej and colleagues for their comments on our study1Shine B McKnight RF Leaver L Geddes JR Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data.Lancet. 2015; 386: 461-468Summary Full Text Full Text PDF PubMed Scopus (161) Google Scholar and helpful suggestions for future investigation. As Judge and Winearls suggest, end-stage renal failure in a patient given lithium could obviously be attributable to factors other than the lithium itself and large-scale, well-controlled prospective studies that investigate various confounders are needed to refine the hazard ratios more exactly. A study combining MRI with biochemical markers would be ideal. We did not look at proteinuria, but the data are available and it seems that many patients with lithium-related nephropathy do not have proteinuria.2Grunfeld JP Rossier BC Lithium nephrotoxicity revisited.Nat Rev Nephrol. 2009; 5: 270-276Crossref PubMed Scopus (215) Google Scholar We would agree that lithium could be continued in selected patients in the context of high intensity renal monitoring. Smith poses an important question: how does age of onset of lithium therapy affect the risk of declining renal function? We did not analyse these data in our initial report, but we will in a planned follow-up study. As far as we know, this question has not been addressed elsewhere, but we welcome other researchers' contributions if they have already looked at such data. We agree with Zaidan that there are limitations in our data, especially those pertaining to a paucity of information about concurrent drugs and cardiovascular comorbidities. We used routinely collected, anonymised biochemical data with no linked clinical details, but these variables should be included in prospective multispecialty studies. To address Zaidan's other points: the number of creatinine measurements is recorded in table 1; age is age at first measurement; 14·6% of patients had eGFR 60 mL/min per 1·73 m2 or less at first measurement, and were excluded from the subsequent analysis. Chronic kidney disease progression and end-stage renal disease will be included in a follow-up study. We agree with most of Rej and colleagues' comments. Unfortunately, our use of routine biochemical data not linked to clinical diagnoses meant that a control group could not be established. Similarly, it is not possible to control for other confounders such as cardiovascular disease, smoking, or antipsychotic drug use. We did not control for inflammatory markers, but the suggestion is interesting, and will be explored in a follow-up study. To clarify, the oldest patients were aged 100 years in both groups (not 67) and 116 patients receiving lithium were aged 80 years or older at first creatinine measurement, of a total of 66 541 people aged 80 years or more in the population. We declare no competing interests. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory dataLithium treatment is associated with a decline in renal function, hypothyroidism, and hypercalcaemia. Women younger than 60 years and people with lithium concentrations higher than median are at greatest risk. Because lithium remains a treatment of choice for bipolar disorder, patients need baseline measures of renal, thyroid, and parathyroid function and regular long-term monitoring. Full-Text PDF Open AccessLong-term effects of lithium on renal functionWe applaud Brian Shine and colleagues for their study (Aug 1, p 461)1 on the effects of long-term lithium therapy on renal, thyroid, and parathyroid function. We would like to raise the issues of diagnosis and management of lithium nephropathy. Full-Text PDF Long-term effects of lithium on renal functionThe Article by Brian Shine and colleagues1 is the best accounting of the long-term adverse effects associated with lithium treatment that has ever been published, and the authors deserve high praise. However, like all strong studies, it answers some questions and poses others. For instance, the analysis suggests that male patients younger than 60 years will have almost no greater decline in renal function than control patients for more than 20 years of treatment (figure 3).1 But this conclusion might inadvertently combine the effects of lithium treatment duration and age. Full-Text PDF Long-term effects of lithium on renal functionIn a retrospective cohort study,1 and by contrast with their previous report,2 Brian Shine and colleagues showed that lithium use was associated with an increased risk of stage 3 chronic kidney disease, which was more likely to occur in women, early in treatment course, and with higher plasma lithium concentrations. Although the investigators were able to collect data on a large number of patients, they were unfortunately burdened by biases that cast uncertainty on interpretation of the results. Full-Text PDF Long-term effects of lithium on renal functionBrian Shine and colleagues' report1 included a large longitudinal analysis that concluded that lithium users have high risk for moderate chronic kidney disease, featured investigation of many long-term users, and detailed measurements of renal function and lithium concentrations. Full-Text PDF" @default.
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• W2215928790 title "Long-term effects of lithium on renal function – Authors' reply" @default.
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